Vertigo and balance disorders
Dizziness, vertigo and dysbalance are among the most frequent symptoms that cause patients to see their doctor. The multitude of underlying diseases requires close collaborations of specialists from different disciplines to ensure optimal diagnosis and therapy. The Interdisciplinary Center for Vertigo & Balance disorders is run by physicians and other medical personnel from the Department of Neurology, the Department of Otorhinolaryngology, Head and Neck Surgery, the Department of Psychiatry and Psychotherapy, and the Institute of Physical Therapy.
Patients with dizziness, vertigo or dysbalance are comprehensively assessed and treated taking into consideration neurological, ontological, psychiatric, and physiotherapeutic aspects of their disorders. A questionnaire, which is sent out together with the appointment and can also be filled out online, facilitates the diagnostic procedure. The first consultation is dedicated to a complete assessment of the medical history and to bedside tests. Thereafter we discuss with the patient, which laboratory tests are required to further delineate the diagnosis and prognosis and to help choosing a rational therapy.
Special consultations are available for patients with disorders of the cerebellum, since evaluations, follow-ups, and novel therapies are particularly demanding. See: Consultation for cerebellar disorders.
A broad battery of various tests measuring functions of the inner ear, vestibular cranial nerve, and areas of the brain controlling balance and eye movements is available:
- video-oculography including caloric ear irrigation
- video and search-coil head impulse testing
- dynamic visual acuity
- subjective visual vertical
- turntable testing
- fundus photography
- cervical vestibular evoked myogenic potentials (cVEMP)
- ocular vestibular evoked myogenic potentials (oVEMP)
- functional gait assessment
The choice of tests depends on the results of the clinical investigation and is thoroughly discussed with every patient. Tests are coordinated such that they can all be completed during a second consultation. Thereafter, we explain the diagnosis to the patient and propose a tailored therapeutic concept.
Neurologists, otologists, psychiatrists and physical therapists hold a weekly interdisciplinary board meeting (Tuesday, 13:30 h). Here patients with complex disorders leading to dizziness, vertigo and dysbalance are being discussed. The main purpose of this board meeting is to develop an individual therapeutic plan for each patient. If possible, the patient is present at the discussion. If not, the patient is informed by phone or at the next consultation about the recommendations of the board.
Canalolith repositioning maneuvers on 3D motorized turntable in patients with therapy-resistant benign paroxysmal positional vertigo
Positional vertigo is the most common form of dizziness. In the majority of patients, this positional vertigo is elicited by changing head position relative to gravity. Calcium cristals, which usually are fixed in the otolith organs, drift freely within the semicircular canals of the inner ear and cause rotational vertigo during sedimentation to the lowest points of the canals. With specific maneuvers, the canals can be liberated from the calcium cristals at the bedside. In complex cases or if patients are immobile (immobile neck, frailty, invalidity etc.) the maneuvers are performed on the 3D turntable.
Prof. Dr. med. D. Straumann
Leading senior physician
Department of Neurology
Interdisciplinary Center for Vertigo & Balance Disorders
University Hospital Zurich
Tel. +41 44 255 55 50